0006-137 (BLCK)- LICENSED CONTRACTOR •DECLARATION ..
r,1µ I hereby -affirm under penalty of perjury that I'arri licensed under provisions of
1- Chapter 9 (commencing with Section 7000) of;Division 3'of the Business and
c*4 W Professionals Code; and my License is in full force and effect.
O =) M License # Lic Class t Exp. Date
CY
,a ti
LU
Z ate Signature of Contractor
H°" OWNER -BUILDER DECLARATION
CID
LU W III -
I hereby affirm under penalty of pequry.,that 1• am exempt from the Contractor's
f1 License'Law for the following reason
•Z ( ) `1,'as- owner of the property, or my employees with-wages'as their sole
compensation, will do the work, and.the structure is not intended or'offered for
sale (Sec. 7044, Business & Professionals Code).
(. } V`B's owner of the property,.am-exclusively'contracting with licensed
contractors, to. construct the project i (Sea 17044, Business & Professionals
Code). C •.
" O I am exempt under Section B&P.C. for this reasonto
N Date Signature of Owner
O.N t 4 s
D7
Q • WORKER'S COMPENSATION.DECLARATION
I hereby affirm+ under penalty. of perjury one of the following declarations
O (,) I have and will maintain a certificate of•consent to elf -insure -for workers'
K W Y= compensation,. as provided for by Section 3700 of .the•. Labor Code,: for. the
J Q performance of the work for which this,permit is issued
b'Q U^I"have.and Will maintain workers'.compensation insurance, as required by
D U' Q Section 3700 of the.Labor.Code, for the performance_of the -work for which'•this
I. rn H perinit,is issued. My workers' compensation •insurancei carrier & policy no. are:
Z ,
cb Carrier, PR. WNT' COO NO. Policy No ; : SF�d ! 100-44179
�' 1
t Q (This section need not -be completed if the permit valuation.js for $100.00 or less).
_J O_ I certify that`in the performance of the work for which this permit is issued;
I shall- not. employ any person in any manner,so as to become'subject to the
workers, compensation_ laws of California, arid agree that if:1.should become
subject'to the workers' compensation provisions of'Section' 3700 of the Labor
3 ' Code, I shall forthwith; comply with those provisions ` +
date: i fi Applicant—
Warning: Failure to secure Workers' Compensation coverage is unlawful'and
shall subject an employer to criminal penalties and, civil fines up to $100,000,.in
addition to the cost of compensation, damages as provided for in�Section 3706
of the Labor Code, interest and :attorney's fees AIf
IMPORTANT Application is hereby made to the: Director of Building and Safety .
for a permit subject' to the; conditions': and, ',,restrictions' set forth on 'his
application.
1. Each person upon whose behalf this application is made & each`person.at
whose request and for whose 'benefit work is performed under 'or pursuant to.
any permit issued as a result of this applicator agrees to, & shall," indemnify
& hold'harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application.. becomes null and void if
work is not commenced within .180''days`4rom•date of issuance'of such
'permit; or cessation of work for -.180 days will,subject permit to cancellation.
I certify that I have read this application and state that the -above information'is
• correct. I agree to comply with all City; and -State laws relating to the building
construction, and hereby authorize -representatives of this,City to,enterupon
the above-mentioried property for inspection purposes : l r
Ignature (Owner/Agent). Date. i
BUILDING PERMIT ' PERMIT"
-�' �
DATE,' VALUATION -.. LOT f TRACT
JOB SITE
APN
�
ADDRESS r8iMVIA, Iriamaxc.eq.
OWNER i
CONTRACTOR / DESIGNER / EN (NEER
/y y�,j•.�gyp rtp .1 �q�•y�y����p1 {y �,yqy �
`+�"KVtd1. AT1 cG�l.+4J.Lgie,T�tilV d... .. -
,+q,p'�'j A�q /� �p }� /s� �,f4: �`teg9r
4,e•7i••7C' IDA & C401l["t`�}.Y Z
15.70 BROOKWUAIS bRft, MME 2N
155 7 0 I RO0KHC)=W DIME, SUITE, 2.0
SAWA MA. CA 92,105
SAWA A14A _ , CA 92,705
� i 14}7 51-9151 CPA.4 4485
j
USE OF PERMIT
160 LIP Q 6'H101-4 14 LF @4' H10H MKIDZNWL - ORCO
STANDARD
6 FT. WAIA, 160.00 l.,b'
4 FT. WALL 14.00 L1P
FSUMAIND C0€ r et F.Ct$NMi7C'J`.P.'0P
4,224.00.
CONSTRUCTION ME ' 101-000.418.000 872.00
A'
• . . ..
n..ri 'Eta
r) 5, y[
SUB -TOTAL CCN tltUMILON A'D O—W C A"M
r/2.90
• 7;89 P��P;~�+.�,
$fJ,UO
r(yr .,8 sm IN
MOO' '
kZ
l Ry •1
RECEIPT
DATE
DATE fT�LEPINSPECTOR
(8Y
y
ti
I\in I DO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms'& Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
a•zJ
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBIN
PROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles ,
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: